title: Subdividing the digital divide: differences in internet access and use among rural residents with medical limitations.
abstract: BACKGROUND
  Access to health care is often contingent upon an individual's ability to travel for services. Certain groups, such as those with physical limitations and rural residents, have more travel barriers than other groups, reducing their access to services. The use of the Internet may be a way for these groups to seek care or information to support their health care needs.
  
  
  OBJECTIVE
  The purpose of this study was to examine Internet use among those whose are, for medical reasons, limited in their ability to travel. We also examined disparities in Internet use by race/ethnicity and rural residence, particularly among persons with medical conditions.
  
  
  METHODS
  We used data from the 2001 National Household Travel Survey (NHTS), a nationally representative sample of US households, to examine Internet use among individuals with medical conditions, rural residents, and minority populations. Internet use was defined as any use within the past 6 months; among users, frequency of use and location of use were explored. Control variables included sociodemographics, family life cycle, employment status, region, and job density in the community. All analyses were weighted to reflect the complex NHTS sampling frame.
  
  
  RESULTS
  Individuals with medical conditions were far less likely to report Internet use than those without medical conditions (32.6% vs 70.3%, P < .001). Similarly, rural residents were less likely to report Internet access and use than urban residents (59.7% vs 69.4%, P < .001). Nationally, 72.8% of white respondents, versus 65.7% of persons of "other" race, 51.5% of African Americans, and 38.0% of Hispanics reported accessing the Internet (P < .001). In adjusted analyses, persons with medical conditions and minority populations were less likely to report Internet use. Rural-urban differences were no longer significant with demographic and ecological characteristics held constant.
  
  
  CONCLUSIONS
  This analysis confirmed previous findings of a digital divide between urban and rural residents. Internet use and frequency was also lower among those reporting a medical condition than among those without a condition. After we controlled for many factors, however, African Americans and Hispanics were still less likely to use the Internet, and to use it less often, than whites. Policy makers should look for ways to improve the access to, and use of, the Internet among these populations.
authors.affiliation: Department and Graduate Institute of Health Services Administration, China Medical University, No.91 Hsueh-Shih Road, Taichung, Taiwan.
authors.forename: Jong-Yi
authors.initials: JY
authors.lastname: Wang
authors.forename: Kevin
authors.initials: K
authors.lastname: Bennett
authors.forename: Janice
authors.initials: J
authors.lastname: Probst
mesh_terms: D000328:Adult; D001741:Black or African American; D006233:Persons with Disabilities; D006297:Health Services Accessibility; D006630:Hispanic or Latino; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008875:Middle Aged; D054525:Minority Health; D012424:Rural Population / Q000706:statistics & numerical data; D014195:Travel; D014505:Urban Population / Q000706:statistics & numerical data